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Here is my letter: "To Whom It May Concern: I am requesting a “fast” appeal or an “expedited review of my appeal”. In September of 2007, Dr. Morton and my PCP submitted a request for approval for Bariatric surgery. I have been denied and since that time my borderline diabetes has turned into full blown diabetes. I have currently been perscribed Metformin 1000 mg twice per day. My doctor and I feel this procedure is medically necessary. Enclosed is another letter from my PCP and the diet I have been following since September of 2007. My father died from diabetes with many complications including having both legs cut off and his fingers decaying. I do not want to live that life. Quoted from the American Diabetes Association: “Weight-loss surgery helps reduce the seriousness of all four of the diseases studied. Diabetes completely disappeared in 76.8% of the patients and was resolved or improved in 86%.” Enlight of the fact I have just become diabetic, this surgery would help me get off of medication and reduce, if not eliminate, the possibility of dying from diabetes. I do not know why an insurance company would deny a patient a chance to live a full and healthy life. Please reconsider this decision." My doctor's letter was also included. In the process of this I also found the step-by-step procedures for BCBS. I saved it in a word document. Is there a way for me to send you an attachment? I'll try to PM it to you. Denise

I'm not a Dr. but your description of what's happening actually didn't sound like reflux to me. Reflux is usually uncomfortable in several different ways. It's essentially hydrochloric acid - the most corrosive acid - coming into contact with tissues it shouldn't contact, and that hurts. What you described sounds more like a stomach that's slow to empty, or liquids "backing up" (can happen if you drink too quickly), or getting a "bubble" stuck or something more along those lines - where it's not the contents of your stomach (as it is with reflux) but things hanging out in your esophagus or some other before-the-stomach area. Reglan (metoclopramide) basically prevents your muscles from relaxing. When our muscles relax, the opening from the stomach can open up (it normally would not) and allow things to slosh back up, just like a ziploc full of liquid will spill out if you unzip the top a bit. It's actually a sphincter, not a ziploc. But that is essentially forced shut, and your stomach goes into a bit of overdrive. My father was on Reglan for a while to help with gastroparesis (partial stomach paralysis, essentially) he developed as a related complication to his lap-band. It was used to -- basically make his stomach start emptying again (gastric emptying). I can tell you - it has some crazy side effects - esp. related to dosage and duration. http://www.medicinen...ral/article.htm BTW, they also give Reglan to lactating mothers who aren't producing sufficient breastmilk. So...

Hello! My name is Denise from California. I am 62 & waiting to see my surgeon hopefully in 2 wks. I'm having the sleeve. After seeing what my younger sister (50ish) & 40 yr old daughter experienced after having the sleeve I thought I would try loosing my weight naturally. I have been attending a Healthy Balance class afford by Kaiser since Dec. 2016 & have lost 10 lbs. Something I haven't been able to do in years after trying several diet plans. Anyway I saw my bariatric Dr. Who mentioned that since I was diabetic that having the surgery would be good for my health since it can bring my diabetes into remission. I was diagnosed with diabetes about 6 yrs ago. He said the longer I have this disease the more likely I can develop complications with my diabetes. Does any have any thoughts or suggestions on this matter? I would appreciate any feed back. Sent from my SM-T530NU using BariatricPal mobile app

nikki9, Yes, I am in the same boat. My BMI is just under the qualifying amount for surgery and only because of the other two diagnoses of sleep apnea and high cholesterol was I approved. My surgeon doesn't even have me doing the pre-op diet. He just asked that I not gain 20 pounds in the next week and half. I also considered the fact that I would be restricted to certain pain medication for the rest of my life and at 38, I don't want to have to fight that battle plus all of the other lifelong restrictions that go along with RNY. I would like to lose 85 pounds and I feel like I can do that with the sleeve. cynthiarm2000, The lifelong complications are exactly what I want to avoid. I am finding that there are way less of those with the sleeve than with the RNY. Thank you for those stats. I am curious to your answer to MisforMimi question though as well. MisforMimi, Thank you for your feedback. To answer some of your questions, I am 38 and my secondary morbidity diagnoses are sleep apnea and high cholesterol, both of which will go away with either surgery. I have been in the pre-op, non-surgical weight loss plan for over a year now and if I don't do the surgery now, it will be after the first of the year. My deductible is met for the year so my out of pocket expense is very low to keep my date as it is. I have known for months that I will be having surgery; it's just recently that I started to question which one. I really like your idea of going to a post op surgery support group prior to surgery and I will look into that. I will also be sure to ask my surgeon which type of stitching he does. Your thought process for you makes sense for your choice. I appreciate that we are all in the same boat of trying to save our lives in one way or another. Good luck to you!

@"mbrinmn" I am in the Deep South and the cost of living is lower. $13500 takes care of it all. Glad u had a good experience. Ive had a few friends go to Mexico with no probs whatsoever. I'm just worried about being in the 1-2% and having a major complication like a leak. No other surgeon is going to be as motivated to "fix it" like the original surgeon. I guess I'm scared that no one would want to touch me after going out of the country for surgery. There's so much fear of lawsuits in the medical field.

I'm with Stacy on the statistical information especially when we factor in band and RNY patients. For me, the sleeve has given me the necessary tool with little long term complications (no slippage, no pouch dilating, no obstructions, or other complications we read about), and I have already "tested" out the sleeve in regards to "cheating". Just for me personally, the 2 weeks leading up to Halloween was pure hell, candy, parties, junk food galore. Yep, I gained a whole whopping 5 pounds to put me up to 131, oh yeah and throw in 2-3 sodas a day, and miscellaneous several glasses of wine and mojitos, I wasn't freaking out over the slight gain because I knew exactly why and how I gained the weight. Once all the parties were over, and life returned to my normal sleeve eating which is anything and everything I want, just protein first, more clear, sugar free fluids, I dropped 7lbs. Just for me, and how my mind works, I know exactly what will lead to a regain. I knew the scale would reveal an increase, but I was also mentally prepared for it. I've learned that the sleeve only does so much, and it really likes those wasted calorie and slider foods. I know what causes the scale to go up, but I also know what it takes to maintain. For my little mental state, I know there are consequences, but I also know how easy it is for me to get back on track and drop the weight.

Hi Everyone! Just wanted to check back in at 9 months post op to say life is FABULOUS! I had my sleeve in Aug 2012 and had a complication free experience. Aside from occasional nausea, I haven't experienced any real negative side effects. I work out 5 times a week with weights and cardio. I had a breast reduction and lift on Friday and I can't believe how amazing I feel. I started my journey at 5'6" 235 lbs. I'm now 160, with a goal weight of 145. I've attached updated pics, although they are pre breast reduction. So, now I look and feel slimmer. Anyhow, just wanted to share a positive, complication free experience. Dr. Mueller in San Diego is excellent! Good luck everyone! Oh and take your vitamins!!

I was banded on 2/22. For the last few days I have had a soreness at the bottom of my esopagus like it is irritated. Whenever I swallow anything it is painful as it passes this point and feel swollen. What are the s/s of erosion? I thought maybe liquids for a couple of days would help. BUT my other problem is that I am so hungry, too! I mean painful hunger pains and feeling like I would throw up from hunger. It's bad. The other day I couldn't eat fast enough (since I am now slow) to get rid of the hunger pain and someone actually had to go get me sugar and spoon! This week I haven't been very good, either. I am so stressed at work and last night I wished I didn't have the band so I could eat, eat, eat. I am scared of having complications since I was banded in Mexico and am basically on my own here. I can call the doc who does my fills - he has a lot fo experience and his scheduler has had a band for 10 years. What do you think?

We've all been there. It certainly does get depressing at points. For myself I was still on liquids at two weeks out and ended up back in the hospital for another 16 days after that. So I was on liquids for about two months. And for 14 of the 16 days back in the hospital I only had food and most liquids through my iv. It was also hard for me to move onto the other stages of puréed and then soft foods. I finally got back to real food at about 3 months out. As far as other people eating in front of me..I just couldn't handle it! If hey wanted fast food they couldn't have it around me. Obviously I was very selfish with that, but ultimately it saved some of my sanity. Feeling bigger after surgery is normally due to all the iv fluids they push in you at the hospital. I felt like I was gonna pop the first and second time I came home. Hang in there the journey gets much better. I'm 4 1/2 months out and would do it all over again even with the complications. HW 229, SW 214, CW 160 RNY 3/14/13

Welcome! The band is definitely on its way out as more and more people are developing complications. You are to be congratulated on your weight loss and I think electing to have a VSG was a great decision. Keep us posted on your progress with getting a date and a care provider for your child.

this article appeared in Slate yesterday. it always strikes me as odd that people find it best bizarre and at worst shameful that there is a surgical cure for obesity and that people are taking advantage of it. anyhoo, happy reading: Radical Reduction The benefits of stomach stapling for teenagers. By Amanda Schaffer Posted Tuesday, Aug. 22, 2006, at 7:27 AM ET Last month, the already grim prognosis for heavy kids took a turn for the even worse. A study of more than 100,000 women, published in the Annals of Internal Medicine, found that those who were overweight at age 18 were more likely to die prematurely in middle age. And research published in the Journal of the American Medical Association showed that people who develop type 2 diabetes—a condition associated with obesity—before the age of 20, as opposed to later, are at greater risk of end-stage kidney disease and death before the age of 55. Obesity at any age is associated with health woes like sleep apnea, fatty liver disease, atherosclerosis, loss of vision, and some types of cancer, in addition to diabetes. But when these conditions appear in the young obese, the long-term ramifications are just scary. How about a radical solution—stomach stapling for teenagers? It may sound crazy and desperate, but several major children's hospitals, including Cincinnati Children's Hospital Medical Center, Texas Children's Hospital, and Lucile Packard Children's Hospital at Stanford, have started offering obesity surgery in recent years. Nightline recently followed a 16-year-old Texas girl who underwent stomach stapling and lost 129 pounds in six months, down from a starting weight of 368. The worry is that such stories distract from workaday efforts to improve school lunches, promote exercise, and establish good eating habits for kids. Critics also point out that stomach stapling is expensive and can cause serious complications, like intestinal leakage, bowel obstruction, and nutritional deficiencies. But for extremely obese teens—especially those who already have a related health problem—less radical treatment options may not work, or at least not work fast enough. Surgery, by contrast, can not only lead to dramatic weight loss but also improve or reverse conditions like sleep apnea and diabetes. Only a small group of kids should be eligible for the surgery, but for these few, it can be a very good thing. In a stomach-stapling operation (the medical term is gastric bypass), a small pouch is created in the upper portion of the stomach, and the small intestine is rerouted to connect with it. The benefit is that a downsized stomach will hold less food and may release fewer hunger-inducing hormones, causing patients to feel full more quickly and stop eating. To be sure, obesity surgery is a risky proposition. One small study, published earlier this year in the Journal of Pediatric Surgery, found that roughly 40 percent of kids who underwent gastric bypass experienced some kind of complication, such as intestinal leakage, dumping syndrome, bowel obstruction, wound infection, or a nutritional deficiency. (A similar complication rate has been found in adults.) Nutritional deficiencies, especially of Calcium, Iron, Vitamin B-1 and vitamin B-12, may occur partly because patients are eating less and partly because the operation bypasses a portion of the digestive tract that efficiently absorbs many Vitamins and minerals. The potential for deficiencies means that patients must adhere to strict guidelines. All patients must eat more lean, high-quality protein; exercise; and take vitamins and minerals for the rest of their lives. Teenage girls must take additional calcium and iron. Critics argue that teens are less likely than adults to follow these rules and are too young to make a decision to undergo major elective surgery. They also argue that the surgery takes on a different social meaning when performed on young people: It seems like giving up and is hard to reconcile with the cherished notion that kids can always grow and change. There's no sense in soft-pedaling these issues. But Thomas Inge, co-founder of the obesity surgery program at Cincinnati Children's Hospital, points out that when teens are more than 100 pounds overweight, the chances are vanishingly small that they will shed the necessary pounds on their own and keep them off. Programs that focus on changing diet and behavior may work for younger children whose eating habits and behavioral patterns are less ingrained; for teenagers, though, the results are often disappointing. Inge has developed guidelines to identify the small group of teens he and other doctors think should be eligible for stomach stapling. (Here's a brief summary.) Preliminary data show that surgery can really help these adolescents. In one study, teens who underwent gastric bypass lost an average of 37 percent of their body mass index by the end of the first year. Other research suggests that the procedure can reverse or improve sleep apnea and type 2 diabetes. Similar health gains have been noted in adults. But that's not necessarily a reason to delay the surgery. Inge points out that the longer a patient has had diabetes, the harder it may be to reverse the condition. The same may turn out to be true for cardiovascular disease, though the data on this are not well-established. Stomach stapling also seems to get riskier the more obese a patient is. So, an extremely heavy teen who is likely to grow into an even heavier adult might be better off opting for surgery sooner rather than later. A procedure that's less risky than stapling, known as adjustable gastric banding, may also soon make surgery a better option. During this procedure, a flexible silicone band is placed, inside the body, around the upper part of the stomach. At follow-up office visits, the band is progressively tightened (here's how). This appears to suppress appetite (perhaps by stimulating stomach fibers associated with feeling full). Gastric banding seems to cause adults to lose weight more gradually on average than gastric bypass. But it has a lower rate of complications. And it's reversible. In 2001, the Food and Drug Administration approved adjustable gastric banding for people over 18. Now a small number of researchers have received permission from the FDA to study it in teens. At NYU Medical Center, about 100 teens have undergone the procedure. About 5 percent have required a second operation because the band slipped out of position. But according to NYU lead surgeon Christine Ren, that's the most frequent complication. To date, there have been no deaths and no hospital readmissions for acute complications. Patients, who weighed 300 pounds on average before surgery, report a decrease in appetite. And they appear to be losing a lot of weight—an average of 95 pounds in the first year. Ren says that adolescents who undergo gastric banding seem to lose weight faster than adults do, perhaps because of differences in metabolism or because they're more, not less, diligent about following the post-surgery rules. There's a lot we still don't know about stomach surgery and its long-term effects when performed on young people. But for kids whose obesity is likely to be life-shortening, not to mention a source of diminished self-confidence and opportunity, the benefits may well outweigh the risks. It's heartening to have a possible life raft to offer them, however bizarre it seems. sidebar Return to article According to Inge's guidelines, teens should have a body mass index of more than 50 kilograms per meter squared or a BMI of more than 40 kg/m2 along with a major medical condition, like type 2 diabetes, sleep apnea, or pseudotumor cerebri, which can cause progressive loss of vision. For a typical obese teen who has stopped growing, a BMI of 50 corresponds roughly to a weight of 300 pounds for girls and 335 pounds for boys. A BMI of 40 corresponds to 250 pounds for girls and 275 pounds for boys. sidebar Return to article During surgery, the band is connected to a small reservoir placed deep under the skin. At follow-up visits, saline solution is injected through the skin and into the reservoir, which causes the band to inflate and tighten around the stomach. (Think of a blood pressure cuff being tightened around the arm.) Amanda Schaffer is a frequent contributor to Slate.

Thanks, Betsy! Yes, the doctor said that we are playing catch up now because he had to unfill the first 2 cc's in that 3rd week. According to him, I am moving along just fine. He is a Bariatric Center of Excellence rated doctor who has personally done well over 700 lap band surgeries alone, not sure how many gastric bypass surgeries in addition to that. He is definitely experienced in this. I agree that I would prefer a more conservative approach than some of the other doctors that I have read about on here that seem to be way too aggressive. I think that would definitely have more propensity to cause complications resulting in PBing and unfills, etc. Betsy, I admire your resolve and self discipline when it comes to your diet. Unfortunately for me, I cannot be that strict with myself all the time. If I do so, then eventually I will have a complete meltdown and cram any and everything I can find into my mouth! I do much better to allow myself a little here and there so I don't feel so deprived over all. But you are right, whatever works for you! Thanks for your input! It is much appreciated! I hope to one day be working on maintenance like you too!

My bariatric surgeon was convinced that my band had slipped, so much so that last week he ordered, and I completed a repeat of the upper GI study I completed in June in a different state with a different surgeon (I have moved since my band was placed). The results showed a perfectly placed band...again. But I appreciated his wanting to be through with his medical opinion. My symptoms are only present at night after I am asleep, and otherwise I am able to eat without any adverse events. My surgeon discussed with me that even with slipped band, some patients are able to eat normally with few complications. With the symptoms I presented with he told me he would be surprised if my band had not slipped. I feel fortunate that it was still in place, otherwise he would have removed it. It will be best to discuss your concerns with your surgeon. I am not a physician, and only am able to share my own experiences!

had my surgery on the 23rd as well.. but i had complication and my shakes didn't start until the 29th had two shakes at the hospital (had Optisource caramel and strawberry) although i wasn't a big fan i was happy to have something other than just plain water. although for the first time in my life i never wanted water more than i have now. on the 30th first day back home I had two more Optisource shakes a day and wasn't too bad, i never finished either one all the way but almost most of it. I also started on sugar free jello (again never happier to have jello). Today I tried costco premier shake (chocolate) and it was so thick it took me about two hours to have half of the shake. for my second shake (also the chocolate premier) i tried it with three ice cubes blended and it was much more easier to drink. the coldness or lighter feel felt easier to drink. I didn't finish it all but almost all the way and this one only took an hour to drink. Hope that helps, i will continue to try new ways of having the shakes and keeping the goal of three shakes a day. Hope this helps a bit Good luck!

I am just shy of 9 months out frommy surgery with Dr Aceves. I have had ZERO complications. They are the best there, you will be in good hands with them. They are all very caring. You can't gp wrong with Dr. Aceves and his team. Brenda

Your friends experience sounds about right! There is plenty to research, its a major surgery and a huge life change but so far I have no regrets...only that I didn't do it sooner. There are plenty of great success stories on this forum and there are very true and difficult complications that folks have had. Read them all! It's given me the restriction and allowed me to have the will to make the right choices. Good luck to you!

My story is similar to yours. My surgeon is very conservative too. I lost 100% ewl before complications after kids. Had my band out and asked my surgeon which would be better for me after band and he said I should do sleeve. Hope he is right bc doing surgery in June! Maybe get another option? I had heard the same things as you about sleeve being less successful but there are plenty of successful revisions on this board. What complications did you have?

I am finally getting my band removed in June. I have had year after year of issues and am VERY happy to be DONE with the band. I want to revise to the sleeve... but my surgeon is not in favor of that. He recommends RNY. He said the success rate with the sleeve after banding is not as high as with revision to RNY. He cites scar tissue as the main reason... with RNY the portion of the stomach with scar tissue is removed. He also thinks the added tool of malabsorption is a big plus. I have decided to wait 6 months after removal before revising to another surgery. That is the length of time he recommended before he would consider a sleeve revision. I was positive I wanted the sleeve... now I am not so sure. Was anyone else pressured to choose RNY and still went forward with the sleeve and are happy they stuck with their gut? I initially lost 100 pounds with the band... regained because of complications. Then lost the 100 again after band re-positioning... regained because of complications again. I have been without fill now since Jan 2014 and am back to my pre surgery weight. I feel like the sleeve will work for me. I was able to work my tool... when IT wasn't malfunctioning. RNY scares the crap out of me. I have no major medical issues other than PCOS and sleep apnea. I have a 20 month old son and I need to be here for him.

You'll get there. You should be really proud of what you have accomplished. Even with the complications you're sticking with it and making it work for you. Good for you!!

there are fewer complications with sleeve, but on the other hand, complications with either surgery aren't very common. And if you do have them, most (for both surgeries) are minor and "fixable". I personally would not let that make or break your decision because most of us sail through these surgeries just fine and don't experience complications. However, since you have GERD and choose the sleeve, know that you have about a 30% chance of that getting worse. That was the reason I went with bypass instead (and I've been very happy with that decision). Of course, you may be one of the 70% for whom it does NOT get worse. I wasn't willing to take the chance, but you might be.

Had vsg in my fifties, had vsg to rny revision recently (almost 2 yrs ago) in my 60s (gerd related). It's been great. Maintained 100+ weightloss over the years. My weightloss rate was on par with others much younger than myself. I had no complications, recovery was very easy for me. As far as long term success, after the honeymoon period, and hunger returns, long term weightloss requires some discipline in following your plan. But since you are already practicing good habits since 2015, you are ahead in the game, and I think you will be very successful.

Hi everyone. So I just joined this app I'm a 17 year old girl. I weigh about 320 and I haven't been able to lose weight easily but I am in this program at my hospital, you meet once a month with a surgeon, occupational therapist, nutritionist, psychologist, and finally a endocrinologist. You have to be in this program for about 6 months in order to be qualified for surgery. I managed to lose a few pounds with this program but I really am struggling to lose it. I just had an appointment Tuesday and this was my 4th month in the program. The surgeon told me that next month, I can make the decision on whether or not I want to go through with surgery. I decided I do want to go through with a surgery and I've decided I wanted the gastric sleeve since it's less risky than the gastric bypass. I've been looking at many before and after pictures of people under the age of 25 and even some older and it does make me excited, hoping that one day I can do a before and after picture like that. My older sister actually had a gastric bypass surgery when she was 23 and she's 25 now and looks great. But, despite my anticipation, I can't help but be terrified. I'm scared of complications, I've had 2 surgeries but they were minor, just tonsils and adenoids, and tubes in my ears, nothing major, the thought of this major surgery scares me. I know it's the right choice for me as I've struggled with my weight since I was just a little girl. I'm sick of being so huge, I want to be able to go out with my friends and not struggle to keep up because I'm always out of breath, I want to go to theme parks and go on rides without fear that I'm too big for the seat belts and bars, I want to be confident, I want to be healthy. But the thought of surgery scares me. I'm scared I might regret getting the surgery. I'm scared there'll be complications. I'm just scared. Has anyone else felt like this before their surgery? Anyone have any advice?

Well it's over surgery was Tuesday. I am home a feeling good. My only complication was I am allergic to the steri strips and my belly has been one itchy mess but they are off and the hives are going away. Only 2 pain pills since I been home since yesterday, no regrets

You probably mean your PTT is elevated. That can happen for a number of reasons, but common culprits are aspirin, excessive Vitamin c, and some antihistamines. If meds are eliminated as the cause, than a hematologist evaluation may be necessary. You definitely need to know if you have true clotting problem before you have surgery. As for the H pylori; It is a fairly common bacteria in the stomach. It usually resolves after one or 2 rounds of a "prev-pack" which is stomach medicine plus antibiotics. It's important to treat this because H pylori can cause ulcers and this could cause post op complications if not addressed. I had h pylori and was treated pre-op and post-op . Everything went very well for me, and without delays . I hope the same for you.

It IS considered ELECTIVE surgery. So many doctors & insurances have stricter guidlines on it. Unlike a surgery that you might HAVE to have where they can't afford to play with your life to wait till your healthier. While I cannot see where smoking can have any effect on the band whatsoever IT CAN have an effect on how fast you heal, or the % that YOU MIGHT have complications. Cause there are very well documented facts that come with smoking that CAN be of concern to the surgeon. Smoking can reduce healing. Nicotine causes the blood vessels to constrict, retarding blood flow to the body. This can also cause the raising of blood pressure too. The build up of the tar and everything else in a smokers lungs often means we dont have the same lung compacity that a non smoker has. Therefore after surgery complication of pnumonia can be higher. Fluid buildup in the lungs after surgery is a COMMON problem that they normallly address after every surgery for smoker and non smoker alike. This build up can also cause a smokers lungs to not be able to utilize the oxygen as well lowing the % Of oxygen in the blood stream which again retards/slows healing. I am a 29 year hard & heavy smoker. And yea I have had nunmerous procedures in the past that smoking hasn't hurt. But I probably didn't recover as quickly as I could have. But I have decided that living past the age of 40 is something I am now going to strive for. So one of the things to go is smoking. I know it's gonna be a challange. And it won't be easy. But dangit my health is worth it. Any day now I gotta go pick my first batch of Patches (Ins wont cover chantix, Waiting on the dr to call em in to pharmacy) And start on that adventure. While not all surgons will insist you stop smoking, many of them will. And honestly they have good reason to. While I know that many like to place the blame on 90% of health problems on smoking they do have some valid reasons for doing so. It all boils down to the fact that smoking does nothing good for our bodies, and if your serious enough to consider surgery for weight loss for your health continuing smoking just don't make alot of sense(at least not to me). Why do something so drastic as elective surgery to improve one area and then refuse to continue to keep improving your health?